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In Brief
Intra-Abdominal Chemotherapy Recommended in Advanced Ovarian CancerThe National Cancer Institute has issued a clinical announcement recommending a combination of intravenous (IV) and intra-abdominal chemotherapy for women with advanced ovarian cancer.
Traditional treatment for women with advanced ovarian cancer includes surgery to remove the tumor followed by IV treatment with a platinum drug such as cisplatin or carboplatin, followed by treatment with a taxane drug, such as paclitaxel. Deborah Armstrong, M.D., at the Johns Hopkins Kimmel Cancer Center in Baltimore, and colleagues conducted a clinical trial in 429 women with advanced ovarian cancer who were treated either with IV paclitaxel followed by IV cisplatin or with IV paclitaxel followed by intraperitoneal (IP, delivered directly into the abdomen) cisplatin and subsequent IP paclitaxel.
Women who received IV paclitaxel followed by IP cisplatin and subsequent IP paclitaxel survived an average of 16 months longer than women treated with IV paclitaxel and cisplatin. Although women who underwent IP chemotherapy experienced more side effects, those side effects appeared temporary and manageable.
The study was published in the January 5 issue of the New England Journal of Medicine.
FDA Approves Revlimid for MDS
The FDA has approved the drug Revlimid (lenalidomide) for use in treatment of patients with myelodysplastic syndrome (MDS). When MDS progresses, it can cause acute myeloid leukemia.
Revlimid works specifically to counter patients' needs for blood transfusions. In a clinical trial, most patients became transfusion free after 3 months and did not need another transfusion for an average of 44 weeks. Common side effects include low platelet count, low white blood cell count, diarrhea, itch, rash, and fatigue.
Prostate Cancer Screening May Not Reduce Risk of Death, Study Says
Prostate cancer screening with prostate-specific antigen (PSA) is not associated with a reduced risk of death, according to a new study.
John Concato, M.D., from Yale University in New Haven, Conn., and colleagues used data from 10 veterans affairs medical centers to identify 501 men aged 50 years and older who had prostate cancer and had died. They also identified 501 men of similar ages who received prostate cancer diagnoses during the same time frame as the other group of men but were still alive.
Fourteen percent of men who died of prostate cancer and 13% of men still living had undergone PSA screening. The authors note that if PSA screening reduced mortality, the percentage of PSA screening among the men who were still alive should have been higher.
In an accompanying editorial, Michael J. Barry, M.D., of the Massachusetts General Hospital, suggests that more studies are needed to identify whether PSA screening is useful. "The key question is whether early detection and subsequent aggressive treatment of prostate cancers found though PSA screening prevents enough morbidity and mortality to overcome these disadvantages," he writes.
The study was published in the January 9 issue of Archives of Internal Medicine.
New Cervical Screening Test Works No Better than a Pap Smear
Liquid-based cytology does not have better accuracy than the conventional Pap smear, according to a study in the January 13 issue of The Lancet.
Conventional screening for cervical cancer has, for the past 30 years, used a method called a Pap smear. Liquid-based cytology was developed as an alternative to the Pap smear. Some reports have suggested that the newer technique can detect more high-grade lesions and decrease the number of slides that are unsatisfactory for doctors to assess.
In a meta-analysis of 1.25 million slides from 56 studies, Elizabeth Davey, of the University of Sydney and New South Wales, and colleagues conclude that the new technique does not increase sensitivity for cervical lesions over conventional techniques. The authors call for large-scale randomized trials to evaluate liquid-based cytology compared with conventional cytology.
Surgery Prevents Endometrial, Ovarian Cancer In Women With Lynch Syndrome
A new study has found that women diagnosed with Lynch syndrome, an inherited condition that puts women at high risk for cancers such as endometrial and ovarian cancers, can prevent these gynecologic cancers if they have their ovaries or uterus removed.
Karen H. Lu, M.D., of the University of Texas M. D. Anderson Cancer Center in Houston, and colleagues identified 315 women with genetic mutations for Lynch syndrome (also known as hereditary nonpolyposis colorectal cancer) and monitored them for endometrial and ovarian cancer. None the 61 women who underwent gynecologic surgery—47 of whom had their uterus and ovaries removed and 14 of whom had only their uterus removed—were diagnosed with clinical endometrial, ovarian, or peritoneal cancer.
Thirty-three percent of women in the control group who did not have their uterus or ovaries removed were diagnosed with endometrial cancer and 5% were diagnosed with ovarian cancer. The authors suggest that removal of the uterus and ovaries could be used as a preventive strategy for ovarian and endometrial cancer in women with Lynch syndrome.
The authors write, "Preoperative counseling should address the trade-offs between the reduction in the risk of cancer and the risks and side effects of surgery, as well as the uncertainties regarding surveillance of gynecologic cancer as an alternative management approach."
The study was published in the January 19 New England Journal of Medicine.
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